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1. (WO1995032011) EXPANDABLE MULTI-FUNCTIONAL MANIPULATING INSTRUMENTS
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WHAT IS CLAIMED IS:
1. A multifunctional instrument for performing various medical procedures in an anatomical cavity comprising
an elongate expandable member having a distal end for being introduced in the anatomical cavity through a relatively small size opening in a wall of the anatomical cavity and a proximal end for being held externally of the anatomical cavity, said elongate member being movable between a non-expanded position wherein said elongate member has a first cross-sectional size to facilitate introduction in the anatomical cavity through the opening and an expanded position wherein said elongate member has a second cross-sectional size larger than said first cross-sectional size; and
an outer member for being disposed over a portion of said elongate member, said outer member constraining said elongate member portion against movement to said expanded position whereby said elongate member adjacent said constrained portion forms a protuberance for contacting anatomical tissue when said elongate member is moved from said non-expanded position to said expanded position, said outer member being movably positionable on said elongate member to vary the location of said constrained portion.

2. A multifunctional instrument as recited in claim

1 and further including means for moving said expandable member from said non-expanded position to said expanded position.

3. A multifunctional instrument as recited in claim

2 wherein said means for moving includes a fluid supply system for supplying fluid to said expandable member to expand said expandable member.

4. A multifunctional instrument as recited in claim

3 wherein said expandable member includes a lumen between said distal and proximal ends and further including an inner member disposed in said lumen and forming a seal with said expandable member, said fluid supply system supplying fluid between said expandable member and said inner member.

5. A multifunctional instrument as recited in claim

4 wherein said expandable member includes a balloon.

6. A multifunctional instrument as recited in claim

5 wherein said balloon has a preformed predetermined shaped.

7. A multifunctional instrument as recited in claim 5 and further including a layer of absorbent material on said balloon for collecting anatomical samples.

8. A multifunctional instrument as recited in claim 5 wherein said balloon is made of stretchable material.

9. A multifunctional instrument as recited in claim

8 wherein said protuberance has a predetermined shape in said expanded position.

10. A multifunctional instrument as recited in claim

9 and further including a handle mounting said proximal end of said expandable member, said handle having a shape corresponding to said predetermined shape.

11. A multifunctional instrument as recited in claim 9 and further including a handle mounting said proximal end of said expandable member, said handle having a shape corresponding to the shape of the anatomical cavity.

12. A multifunctional instrument as recited in claim 4 and further including a second outer member for being disposed over a second portion of said expandable member, said second outer member constraining said expandable member second portion against movement to said expanded position whereby said expandable member adjacent said constrained second portion forms a second protuberance for engaging anatomical tissue when said expandable member is moved from said non-expanded position to said expanded position, said second outer member being movably positionable on said expandable member to vary the location of said second constrained portion.

13. A multifunctional instrument as recited in claim 12 wherein said expandable member adjacent said second constrained portions defines first and second expandable portions and further including first and second channels along said inner member for coupling said fluid supply system with said first and second expandable portions for selectively, individually moving said first and second expandable portions between said non-expanded position and said expanded position independently of one another.

14. A multifunctional instrument as recited in claim 1 wherein said expandable member includes a lumen between said distal and proximal ends and further including an inner member disposed in said lumen and means on said outer member for cooperatively engaging said inner member to guide movement of said outer member along said inner member.

15. A multifunctional instrument as recited in claim 14 wherein said outer member includes a collar and said means for cooperatively engaging includes at least one protrusion on said collar and further including at least one recess on said inner member for cooperatively engaging said protrusion.

16. A multifunctional instrument as recited in claim 1 wherein said expandable member is made of absorbent material movable from said non-expanded position to said expanded position in response to absorption of body fluids by said absorbent material.

17. A multifunctional instrument as recited in claim 1 and further including locking and releasing means for locking said outer member in position on said expandable member to prevent movement of said outer member relative to said expandable member and for releasing said outer member for movement relative to said expandable member.

18. A multifunctional instrument as recited in claim 17 wherein said locking and releasing means includes a locking member mounted on said outer member to be normally disposed in a locked position wherein said locking member is in locking engagement with said expandable member and said releasing member includes a resilient collar disposed over said outer member for moving said locking member from said locked position to an unlocked position wherein said locking member is disengaged from said expandable member to permit movement of said outer member relative to said expandable member in response to squeezing of said collar.

19. A multifunctional instrument as recited in claim 17 wherein said expandable member includes a lumen between said distal and proximal ends and further including an inner member disposed in said lumen, said inner member having a recess extending longitudinally along an outer surface thereof, said locking and releasing means including a locking member mounted on said outer member to be disposed in a locked position wherein said locking member is in locking engagement with said expandable member to prevent longitudinal movement of said outer member relative to said expandable member when said outer member is in a first rotational position on said expandable member wherein said locking member is not aligned with said recess and an unlocked position when said outer member is rotated relative to said expandable member to a second rotational position wherein said locking member is aligned with said recess to permit longitudinal movement of said outer member along said expandable member.

20. A multifunctional instrument as recited in claim 17 wherein said locking and releasing means is formed by configuring an inner surface of said outer member to have a first non-circular cross-sectional configuration and an outer surface of said expandable member to have a second non-circular cross-sectional configuration, said first and second cross-sectional configurations being aligned with one another when said outer member is in a first rotational position on said expandable member to permit longitudinal movement of said outer member along said expandable member and being non-aligned with one another when said outer member is in a second rotational position on said expandable member to prevent longitudinal movement of said outer member along said expandable member.

21. A multifunctional instrument as recited in claim 1 and further including means for adjusting the angular orientation of said expandable member distal end.

22. A multifunctional instrument for performing various medical procedures in an anatomical cavity comprising
an elongate inner member having a distal end for being introduced in the anatomical cavity through an opening in a wall of the anatomical cavity, a proximal end for being held externally of the anatomical cavity and a lumen between said distal and proximal inner member ends for receiving medical instruments;
a middle member disposed over said inner member and having a distal end for being introduced in the anatomical cavity through the opening, a proximal end and a lumen between said distal and proximal middle member ends for receiving said inner member, said middle member being movable between a non-distended position wherein said middle member extends along said inner member and a distended position wherein said middle member is disposed outwardly of said inner member; and at least one outer member disposed over a portion of said middle member for preventing movement of said middle member portion to said distended position to control the shape of said middle member in said distended position in accordance with a medical procedure to be performed in the anatomical cavity.

23. A multifunctional instrument as recited in claim

22 wherein said outer member has a cross-sectional size corresponding substantially to the cross-sectional size of the opening to permit said outer member to extend along the opening whereby movement of said middle member to said distended position is prevented along the cavity wall, said middle member including a distensible portion adjacent said outer member for being disposed in the anatomical cavity, said distensible portion having a cross-sectional size in said non-distended position substantially the same as the cross-sectional size of said outer member to facilitate introduction through the opening and a cross-sectional size in said distended position larger than said cross-sectional size of said outer member for contacting anatomical tissue.

24. A multifunctional instrument as recited in claim

23 wherein said distensible portion has a predetermined circular configuration along the length of said distensible portion in said distended position.

25. A multifunctional instrument as recited in claim 23 wherein said distensible portion has a predetermined triangular configuration along the length of said distensible portion in said distended position.

26. A multifunctional instrument as recited in claim 23 wherein said distensible portion has a pear-shaped configuration in said distended position.

27. A multifunctional instrument as recited in claim 23 wherein said distensible portion has a predetermined oval configuration along the length of said distensible portion in said distended position.

28. A multifunctional instrument as recited in claim

23 wherein said distensible portion has a predetermined oblong configuration along the length of said distensible portion in said distended position.

29. A multifunctional instrument as recited in claim

24 wherein said distensible portion has a predetermined oval configuration in cross-section in said distended position.

30. A multifunctional instrument as recited in claim 23 wherein said distensible portion has a predetermined cup shape configuration in cross-section in said distended position for supporting tissue in a cupping manner.

31. A multifunctional instrument as recited in claim 23 wherein said distensible portion has a configuration in cross-section forming a plurality of protuberances with troughs therebetween for drainage of fluids along said troughs .

32. A multifunctional instrument as recited in claim 23 wherein said at least one outer member includes a plurality of outer members disposed over respective portions of said middle member for preventing movement of said middle member portions to said distended position and said middle member includes a plurality of distensible portions adjacent said outer members, said distensible portions having cross-sectional sizes in said non-distended position substantially the same as the cross-sectional sizes of said outer members and cross-sectional sizes in said distended position larger than said cross-sectional sizes of said outer members.

33. A multifunctional instrument as recited in claim 23 and further including a head assembly mounting said proximal ends of said inner member and said middle member, said head assembly including a valve for selectively opening and closing said lumen of said inner member.

34. A multifunctional instrument as recited in claim 33 wherein said head assembly includes at least two valves for selectively opening and closing said inner member lumen.

35. A multifunctional instrument as recited in claim 23 wherein said inner member includes a longitudinal axis and said outer member includes a plurality of legs with spaces therebetween through which said middle member is moved when said middle member is moved from said non-distended position to said distended position to form a plurality of spaced lobes extending in a direction outwardly of said axis.

36. A multifunctional instrument as recited in claim 23 wherein said outer member has forward and rearward edges for contouring said distensible portion in said distended position.

37. A multifunctional instrument as recited in claim 23 wherein said outer member is movable along the length of said middle member to change the position, size and configuration of said distensible portion.

38. A multifunctional instrument as recited in claim 23 wherein said middle member is disposed over said inner member with a snug fit and said outer member is disposed over said middle member with a snug fit and further including a fluid supply system and at least one channel along said inner member coupling said fluid supply system with said distensible portion to allow fluid flow along said outer member for supplying fluid between said middle member and said inner member to distend said middle member.

39. A multifunctional instrument as recited in claim 23 wherein said middle member is disposed over said inner member with a loose fit and said outer member is disposed over said middle member with a snug fit and further including a fluid supply system and at least one channel along said inner member coupling said fluid supply system with said distensible portion to allow fluid flow along said outer member for supplying fluid between said middle member and said inner member to distend said middle member.

40. A multifunctional instrument as recited in claim 23 and further including a head assembly mounting said proximal ends of said inner member and said middle member and a fluid supply system including a fluid supply passage in said head assembly coupled with said distensible portion.

41. A multifunctional instrument as recited in claim 23 wherein said middle member is disposed over said inner member with a loose fit and said outer member is disposed over said middle member with a loose fit to allow fluid flow between said middle member and said inner member along said outer member and further including a fluid supply system for supplying fluid between said middle member and said inner member to distend said middle member.

42. A multifunctional instrument as recited in claim 41 and further including at least one channel along said inner member coupling said fluid supply system with said distensible portion to further facilitate fluid flow along said outer member.

43. A multifunctional instrument as recited in claim 23 wherein said middle member is disposed over said inner member with a snug fit and said outer member is disposed over said middle member with a loose fit to allow fluid flow between said middle member and said inner member along said outer member and further including a fluid supply system for supplying fluid between said middle member and said inner member to distend said middle member.

44. A multifunctional instrument as recited in claim 43 and further including at least one channel along said inner member coupling said fluid supply system with said distensible portion to further facilitate fluid flow along said outer member.

45. A multifunctional instrument as recited in claim 22 and further including means for adjusting the angular position of said inner member distal end to correspondingly adjust the angular position of said middle member distal end.

46. A multifunctional instrument as recited in claim 45 wherein said adjusting means includes at least one wire connected with said inner member distal end and at least one control wheel for winding and unwinding said wire.

47. A method of performing an operative procedure in an anatomical cavity comprising the steps of
introducing a distal end of a distensible member of a multifunctional medical instrument in the anatomical cavity through a relatively small size opening in a wall of the anatomical cavity with the distensible member in a non-distended position facilitating introduction of the distensible member through the opening;
moving the distensible member from the non-distended position to a distended position to increase the cross-sectional size of the distensible member;
constraining selected portions of the distensible member against movement to the distended position to selectively contour the distensible member to have a plurality of protuberances for engaging anatomical tissue in accordance with the operative procedure to be performed; and performing an operative procedure in the anatomical cavity with the multifunctional instrument in the distended position.

48. A method of performing an operative procedure as recited in claim 47 wherein said step of constraining includes constraining said distensible member along the opening.

49. A method of performing an operative procedure as recited in claim 47 wherein said step of constraining includes, prior to said step of introducing the distensible member, assembling a plurality of collars over the selected portions of the distensible member to prevent movement of the distensible member portions to the distended position.

50. A method of performing an operative procedure as recited in claim 47 wherein said step of constraining further includes adjusting the position of the collars on the distensible member to adjust the contour of the distensible member in the distended position.

51. A method of performing an operative procedure as recited in claim 50 wherein said step of moving includes supplying fluid to the distensible member to distend the distensible member.

52. A method of performing an operative procedure as recited in claim 50 wherein said step of supplying fluid includes contacting body fluid with the distensible member for absorption by the distensible member.

53. A method of performing an operative procedure as recited in claim 47 wherein said step of performing includes introducing medical instruments in the anatomical cavity through a lumen of the multifunctional instrument.

54. A method of performing an operative procedure as recited in claim 47 wherein said step of performing includes manipulating anatomical tissue with the distensible member in the distended position.

55. A method of performing an operative procedure as recited in claim 47 wherein said step of performing includes separating adhering tissue with the distensible member in the distended position.

56. A method of performing an operative procedure as recited in claim 53 and further including stabilizing the multifunctional instrument relative to the anatomical cavity with the distensible member in the distended position to stabilize instruments introduced through the lumen.

57. A method of performing an operative procedure as recited in claim 47 wherein said step of performing includes collecting anatomical cell samples with the distensible member .

58. A method of performing an operative procedure as recited in claim 47 and further including changing the angular orientation of the distensible member distal end subsequent to introduction in the anatomical cavity.

59. A method of performing endoscopic procedures in an anatomical cavity comprising the steps of
inserting a sleeve through a wall of the anatomical cavity for insertion of instruments into the anatomical cavity;
providing a balloon within the anatomical cavity; and manipulating organ structures within the anatomical cavity using the balloon.

60. A method of performing endoscopic procedures as recited in claim 59 wherein the balloon is carried by a member extending through the sleeve and said manipulating step includes moving the member externally of the anatomical cavity.

61. A method of performing endoscopic procedures as recited in claim 59 wherein said manipulating step includes separating organ structures.

62. A method of performing endoscopic procedures as recited in claim 59 wherein said manipulating step includes separating the anatomical cavity wall from organ structures within the anatomical cavity.

63. A method of performing endoscopic procedures as recited in claim 59 wherein said manipulating step includes elevating one organ structure relative to another organ structure.

64. A method of performing endoscopic procedures as recited in claim 59 and further comprising, prior to said manipulating step, the step of inflating the balloon.

65. A method of performing endoscopic procedures as recited in claim 59 wherein said manipulating step includes inflating the balloon.